What You Need To Know About Lead

by Heidi Green
July 13, 2012

“Lead poisoning” sounds dramatic and deliberate, but it is a serious health disorder affecting nearly a half-million U.S. children. It goes largely undetected because it is caused by a substance that is often too small to see and that can be present in air, soil, water, and products that are commonly used everyday.

Even in small amounts, lead can cause a host of health problems, including developmental delays, reduced IQ, and behavioral problems. It can affect the cardiovascular, immunological, and endocrine systems. High lead levels can cause nervous system and brain damage, behavior and learning problems (such as hyperactivity), kidney damage, slowed growth, hearing problems, and headaches.

It is estimated that 535,000 U.S. children ages 1–5 years experience lead poisoning. According to the American Academy of Pediatrics (AAP) children under the age of 6 years old are at higher risk of lead exposure, by:

• getting lead dust from old paint or tracked-in dirt on their hands or toys, then in their mouth
• breathing in lead dust from old paint
• eating paint chips or dirt that contains lead
• drinking water from old pipes lined or soldered with lead
• playing with improperly painted toys or jewelry

Lead-based paint in their environment—on toys, in old paint, from old pipes, in dust—is the most common source of lead exposure, but some children are exposed before birth or while breastfeeding, due to lead in their mothers’ bodies.

Lead is especially dangerous to children because it can affect their developing brains and nervous systems, and because their small and growing bodies absorb more lead. According to the Agency for Toxic Substances and Disease Registry, an adult will excrete, within a couple of weeks, about 99 percent of the amount of lead taken in through any exposure; by comparison, a child, during the same timeframe, will excrete less than one-third of the lead taken in.

Any amount of lead puts children at risk for health problems that can adversely affect their growth and development. The effects of lead exposure will not reverse on their own, even when lead levels drop. However, intervention by health care providers and supportive services by early childhood providers can reduce the effects of lead exposure.

The first step is recognizing that a problem exists. That can be more difficult than you might think.

Identifying lead-exposed children
Unfortunately, lead poisoning is hard to detect. Young children have trouble communicating how their body feels. Early symptoms are common to many other illnesses, and include persistent tiredness, irritability, loss of appetite, stomach discomfort, reduced attention span, anemia, insomnia, and constipation. Children may seem to lose developmental skills they had mastered, like walking, sitting, or passing objects from hand to hand.

Very high levels of lead may cause vomiting, staggering walk, muscle weakness, seizures, and coma. But even many children with high lead levels show none of these symptoms. They seem perfectly healthy. Still, if this problem is left undetected and untreated—if the source of exposure is not corrected and their body continues to accumulate the heavy metal—it can cause long-term, permanent damage to their health.

Children’s blood lead levels tend to increase rapidly from 6 to 12 months of age—as both their mobility and interactions with their environment increase—and peak at 18 to 24 months of age. The only way to know your child’s blood lead level is to have him tested.

Blood tests are often routinely recommended for children ages 1 to 2 years old, and your child’s pediatrician may schedule this as part of your child’s well care visits. However, the test can be used for babies—even newborns—who are exposed to lead during pregnancy or while breastfeeding.

A small sample of blood is taken by fingerstick or syringe, either from the child’s clean fingertip (“fingerstick” procedure) or via a syringe in their arm (“venous collection”); for newborns, umbilical cord blood can be used. Since fingerstick samples can be contaminated during the testing process, an initial high result is typically followed by a venous collection, usually within a week after the first test. For either kind of testing, the sample is sent to a laboratory, which will report the results in micrograms of lead per deciliter of blood. Follow-up testing at three month intervals can help your child’s pediatrician know if the problem is resolving.

The AAP recommends that, at a minimum, blood lead screening be offered to every Medicaid-eligible child at age 1 and again at age 2.

Additionally, in an adaptation from a resource provided by the Centers for Disease Control and Prevention (CDC), the AAP provides some guidance to help parents determine whether they ought to pursue lead screening for their child. If you answer “yes” to any of these questions (questions 1, 2, and 3 are particularly critical), you should talk with your child’s doctor about testing:

1. Does your child live in or regularly visit a house built before 1950? (This includes a babysitter or relative’s home.)
2. Does your child live in or regularly visit a home built before 1978 that has been remodeled within the past six months? Do you have plans for remodeling your home?
3. Does your child have a sibling or playmate who has been treated for lead poisoning?
4. Does your child live with an adult whose job or hobby involves exposure to lead?
5. Does your child live near an industry likely to release lead into the environment, such as an active lead smelter or a battery recycling plant?
6. Does your child live within one block of a major highway or busy street?
7. Has your child ever been given home remedies (also called “folk remedies” or “traditional medicine”) such as azarcon, greta, or pay looah?
8. Has your child ever lived outside the U.S.?
9. Does your family use pottery or ceramics for cooking, eating, or drinking?
10. Does your family use hot tap water for cooking or drinking?
11. Have you seen your child eat paint chips?
12. Have you seen your child eat soil or dirt?
13. Have you been told your child has low iron?
14. Were you exposed to lead during pregnancy?

Children or other family members who have been exposed to high levels of lead may also be tested. Since 1997, the CDC has recommended follow-up testing for children with lead levels of 10 micrograms per deciliter (mcg/dL) or more, but newer research on serious health effects at lower levels has led the agency to reduce its standard. In May 2012, the CDC accepted the recommendation of its Advisory Panel and recognized 5 micrograms per deciliter (mcg/dL) of blood as warranting intervention and follow-up, including developmental assessment, environmental survey of lead source, and blood lead level monitoring. Children with raised blood lead levels should also be tested for iron deficiency, since lead interferes with the absorption of iron. Levels from 2 to 5 mcg/dL generally call for follow-up with a health care provider.

Some experts believe it’s a good idea for all children to be screened at age 1 and again at age 2, regardless of Medicaid level or identifiable risk. My family’s experience bears this out. Although our house was built in 1940, the inside has few painted surfaces; the window casings are vinyl. When we bought our home, there was no lead paint disclosure in the purchase agreement. When we had the wooden portions of our mostly-brick home repainted several years later, lead was not on our minds—or, apparently, our painters’.

Thankfully, our children’s pediatrician routinely orders lead screening tests for all of her patients at 12 to 18 months of age. The testing showed toddler Katie had high blood lead levels. We can’t know for sure whether she put a small chip of paint in her mouth, or if dust was tracked into the house and onto items she touched. But it was a shock to hear her health was at risk due to something so preventable. (Fortunately, Katie’s lead levels decreased within several months, and she has had no ill effects since.)